Provider Demographics
NPI:1841642717
Name:DIABETES & OBESITY CONTROL LLC
Entity type:Organization
Organization Name:DIABETES & OBESITY CONTROL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-564-6605
Mailing Address - Street 1:176 LONGVILLE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LONGVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70652-5036
Mailing Address - Country:US
Mailing Address - Phone:337-564-6605
Mailing Address - Fax:337-433-3013
Practice Address - Street 1:176 LONGVILLE CHURCH RD
Practice Address - Street 2:
Practice Address - City:LONGVILLE
Practice Address - State:LA
Practice Address - Zip Code:70652-5036
Practice Address - Country:US
Practice Address - Phone:337-564-6605
Practice Address - Fax:337-433-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty